Buale Sakow Nutrition Assessment - April 2006

Transkript

BUALE AND SAKOW DISTRICTS
MIDDLE JUBA REGION
SOMALIA
Nutrition Assessment Report
April 2006
Food Security Analysis Unit (FSAU/FAO)
World Vision International
United Nations Children’s Fund (UNICEF)
World Food Program (WFP)
Buale Sakow Districts Nutrition Assessment, April 2006
FSAU/\WVI/UNICEF/WFP
TABLE OF CONTENTS
TABLE OF CONTENTS.............................................................................................................. 2
ACKNOWLEDGEMENT ............................................................................................................ 3
ABBREVIATIONS AND ACRONYMS ..................................................................................... 4
EXECUTIVE SUMMARY .......................................................................................................... 5
SUMMARY FINDINGS FOR BUALE SAKOW ASSESSMENT............................................. 6
1
INTRODUCTION ................................................................................................................ 7
2
BACKGROUND INFORMATION ..................................................................................... 8
3
METHODOLOGY ............................................................................................................. 12
4
THE ASSESSMENT RESULTS........................................................................................ 16
5
DISCUSSION AND CONCLUSIONS .............................................................................. 29
6
CONCLUSION AND RECOMMENDATIONS ............................................................... 30
7
APPENDICES .................................................................................................................... 30
8.
ASSESSMENT TEAM....................................................................................................... 49
9.
REFERENCES ................................................................................................................... 50
2
ACKNOWLEDGEMENT
WVI provided the logistical support and organization, and with funding from UNICEF, met the
cost of enumerators (mainly WVI staff), supervisors, data entry and vehicle hire. WFP provided
their National VAM officer who worked together with the FSAU food security analyst
collected qualitative data.
FSAU provided technical coordination of the assessment through two nutritionists, four
nutrition field analysts (supervisors) and a food security analyst. FSAU trained the assessment
team, coordinated and supervised data collection, entry and analysis, produced the draft and
final reports. Participating agencies (FSAU nutrition and food security team, WVI, UNICEF
and WFP) reviewed and provided comments on the draft report which have been incorporated
into this report.
FSAU, WVI, UNICEF and WFP greatly appreciate the contribution of local authorities in
ensuring security for the fieldwork in Buale and Sakow districts. The data could not have been
obtained without the co-operation and support of the communities assessed, especially the
mothers and caregivers who took time off their busy schedules to respond to the interviewers.
Their involvement is highly appreciated.
FSAU, WVI, UNICEF and the WFP also express their sincere appreciation to the entire
assessment team for the high level of commitment, diligence and ingenuity demonstrated
during all stages of the assessment.
3
ABBREVIATIONS AND ACRONYMS
ARI
FAO
FSAU
GAM
HAZ
HAZ
IDP
MCH
MUAC
NCHS
NGOs
NGO
NIDs
SACB
SMART
UN
UNDP
UNHCR
VAD
UNICEF
WAZ
WFP
WHO
WHZ
Acute Respiratory Infections
Food and Agriculture Organisation
Food Security Analysis Unit
Global Acute Malnutrition
Height- for- Age Z scores
Height for Age Z scores
Internally Displaced Person
Maternal and Child Health
Mid Upper Arm Circumference
National Centre for Health Statistics
Non-Governmental Organisations
International Non-Governmental Organisation
National Immunisation Days
Somalia Aid Coordination Body
Standardised Monitoring & Assessment of Relief and Transitions
United Nations
United Nations Development Programme
United Nations High Commission of Refugees
Vitamin A Deficiency
United Nations Children’s Fund
Weight for Age Z Scores
World Food Programme
World Health Organisation
Weight for Height Z scores
4
EXECUTIVE SUMMARY
Buale and Sakow districts are located in Middle Juba Region. Buale district has an estimated population
size of 46,520 and Sakow, 87,935 (WHO, 2005 NIDS figures further verified by the survey team). The
two districts are located along the Juba River.
The FSAU led Post Deyr 2005/6 Food Security and Nutrition situation analysis/projections for January
through June 20061, classified most parts of Buale and Sakow districts as faced with a humanitarian
emergency and other areas, an acute food and livelihood crisis/high risk of humanitarian emergency.
This was primarily attributed to the impact of below normal Gu 2005 rains, followed by completely
failed Deyr 2005/6 rains which resulted in complete crop failure. This impacted negatively on the lives
and livelihoods of the populations groups. From April 22nd-27th, 2006, FSAU, WVI, UNICEF and WFP
conducted a joint assessment to analyze the nutrition situation and retrospective mortality rates in Buale
and Sakow districts. A 30 by 30 cluster sampling methodology was used and 898 children and 347
adult women aged 15 – 49 years were assessed. Mortality data was collected from 927 households.
Findings indicate global acute malnutrition rate (weight for height <-2 Z score or oedema) of 21.9%
(CI:19.3-24.8) and severe acute malnutrition (weight for height <-3 Z score or oedema) of 6.6% (CI:5.18.4). This highlights a critical nutrition situation (WHO) and a worsening one when compared to long
term estimates of malnutrition for the area. Additionally, about 40% of the 97 assessed pregnant women
had MUAC < 23.0 cm, while 3% of the 250 non-pregnant women had MUAC <18.5cm and were
categorized as malnourished. The crude mortality rate was 0.61 (CI: 0.39 – 0.83) deaths/10,000/day and
the under five mortality rate 1.98 (CI:1.26 – 2.69) deaths/10,000/day which are acceptable (WHO).
About 38% of the children were introduced to complementary foods at the age of 6 months and above.
A summary of assessment findings is indicated in the table below.
Qualitative data indicates poor household food access due to high food prices, and general unavailability
of animal products, most of the livestock having either died, migrated back to areas of origin or, in too
poor body condition to provide milk and milk products.
The critical nutrition situation is attributed to poor dietary intake and presence of communicable
diseases. About 30% of the children came from households consuming a poorly diversified diet
comprising of three or fewer food groups2. Previous studies have indicated an association between
malnutrition and dietary diversity. Additionally, about 49% of the children reported having suffered
from an episode of a communicable disease in the preceding two weeks.
The high disease incidence may be partly attributed to limited access to preventive and curative health
care services, with Sakow district having no health facility. However, in Buale, WVI/UNICEF operates
an MCH/OPD/EPI with 38 health posts. Additionally, about 75% of the children came from households
which consume water from unsafe sources (the river, unprotected wells or water catchments) and about
50% came from households that dispose of faecal matter in the bush. Consumption of unsafe river
water is a possible cause of diarrhoeal infections and subsequent malnutrition.
Mitigating factors include vitamin A supplementation (69%) and measles vaccination coverage (about
93%) attributed to the recent immunization campaigns in Buale and Sakow districts. Nevertheless these
are below the SPHERE minimum recommendation of 95%. About 64% of the children came from
households reporting to access formal humanitarian support in the preceding three months, mainly in the
form of food assistance (about 46%) in February 2006; and informal humanitarian support, mainly in the
form of gifts (about 43%). About 0.12% of the assessed population was reported to have night
blindness3. On-going humanitarian interventions which may also have mitigated the nutrition situation
1
FSAU Technical Series No. IV 8
FAO classification
3
SPHERE recommends night blindness prevalence of < 1%
2
5
include: food assistance by the WFP/WVI, health care services, a water and sanitation program in Buale
by the World Vision and supplementary feeding by the African Muslim Aid (AMA).
The assessment team recommends: improved access to food (short & long term approaches), health care
services; safer water for consumption; and rehabilitation of the malnourished children and women.
SUMMARY FINDINGS FOR BUALE SAKOW ASSESSMENT
Indicator
No.
Percentage
Under-five children screened during the assessment.
Number of boys in the sample
Number of girls in the sample
Number of households assessed
Total population in the assessed households
898
420
478
548
5439
100
46.8 (43.5-50.1)
53.2 (49.9-56.5)
100
100
Global acute malnutrition - Weight For Height Index in Z-Score or presence of oedema
Severe acute malnutrition - Weight For Height Index in Z-Score or presence of oedema
197
59
150
21.9(CI:19.3-24.8)
6.6 (CI:5.1-8.4)
16.7 (14.4-19.3)
Severe acute malnutrition - Weight For Height in % Median or presence of oedema
Proportion of Malnourished pregnant women MUAC<23.0cm N=97
Proportion of severely malnourished pregnant women MUAC<20.7cm N=97
Proportion of Malnourished Non-pregnant women MUAC<23.0cm N=250
39
39
18
8
4.3 (3.1-5.9)
40.2 (30.4-50.7)
18.6 (11.4-27.7)
3.2 (1.4-6.2)
Proportion of children from households that consumed ≤ 3 food groups N=898
Proportion of children from households that consumed ≥ 4 food groups N=898
273
626
30.4 (25.4 – 36.5)
69.6 (64.5 – 74.6)
Proportion of children with diarrhoea in two weeks prior to the assessment N=898
Proportion of children with ARI in two weeks prior to the assessment.
N=898
Proportion of children with suspected malaria in two weeks prior to the assessment. N=898
Proportion of children with Measles in one month prior to the assessment.
Proportion of people with suspected night blindness n=5439
Proportion of children supplemented with Vitamin A in six months prior to the assessment.
Proportion of children (> 9 months) immunised against Measles. N=873
Proportion of children immunised against Polio N=898
246
128
238
181
66
562
812
816
27.3 (24.5-30.5)
14.3 (12.1-16.8)
26.5 (23.7-29.5)
21.3 (18.7-24.1)
0.12
68.6 (65.3-71.8)
92.5 (91.6-94.6)
90.0 (87.8-92.1)
Proportion of children (< 24 months) breastfed less than 6 months N=294
Proportion of children introduced to food before 4 months. N=353
Proportion of children introduced food after 6 months of age N=353
58
121
252
19.7 (15.3-24.7)
18.2 (15.4-21.4)
37.8 (34.2-41.7)
Proportion of children from resident households
N=898
Proportion of children from displaced households
N=898
Proportion of children from returnee/refugee households: N=898
Proportion of children from internal migrant households: N=898
Main source of food
Purchases
N=895
Humanitarian food assistance
N=895
Household own crop production
N=895
Main Livelihood: Riverine
Proportion of children from HH receiving informal support, mainly gifts
Proportion of children from HH receiving formal support (free food aid 45.6%)
Main source of drinking water is the river N=898
Proportion of children from HH disposing off Feacal into the bush
Crude Mortality Rate CMR (90 days recall period) N=5439
Under-five Mortality Rate (90 days recall period) U5MR N=1669
824
24
46
3
91.6 (89.5-93.3)
2.8 (1.8-4.2)
5.3 (4.0-7.1)
0.3 (0.1-1.1)
Global acute malnutrition - Weight For Height Median or presence of oedema
6
530
59.3 (55.9-62.6)
133
15.1 (12.8-17.7)
85
9.9 (8.0-12.1)
442
51.7 (48.3-55.1)
153
15.3 (15.2-20.4)
570
64.5 (60.2-66.7)
426
49.2 (45.8-52.6)
436
50.3 (47.0-53.7)
0.61 (0.39 – 0.83)
1.98 (1.26 – 2.69)
1 INTRODUCTION
Buale and Sakow districts are located in the Middle Juba Region. Buale district has an estimated
population size of 46, 520 and Sakow, 87,935 (WHO, 2005 NIDS figures further verified during the
survey team training). The two districts are located along the Juba River. Buale district has five main
livelihood zones: the southern inland pastoral (5%), southern east pastoral (15%), southern agropastoral
(25%), Southern Juba riverine (50%) and the urban (5%). Sakow district has four livelihood zones: the
southern agro-pastoral (45%), Juba pump irrigated riverine (30%), southern inland pastoral (20%) and
urban (5%).
P!
Nutrition Assessment Area
Phase Classification
1 Generally Food Secure
!P
2 Chronically Food Insecure
3 Acute Food and Livelihood Crisis
Nutrition Assessment Area
4 Humanitarian Emergency
Livelihood Zones
5 Famine/Humanitarian Catastrophe
Juba pump irrigation: Tobacco, onions, maize
Early Warning Levels for worsening Phase
Alert
Southern Agro-Pastoral: Camel, cattle, sorghum
Moderate Risk colour of diagonal lines
Southern Juba riverine: Maize, sesame, fruits & vegetabl
High Risk
Lower Juba Agro-Pastoral: Maize & cattle
indicates severity
Sustained Phase 3, 4 or 5 for > 3 yrs
Areas with IDP Concentrations
South-East Pastoral: Cattle, sheep & goats
Southern inland pastoral: Camel, sheep & goats
Sakow is one of the worst affected districts in Middle Juba region from a decade old civil strive and
natural calamity. Since 2000, the district has experienced the cumulative effect of drought, poor harvest,
reduced pastures and population movement causing deterioration in food security. UN agencies and
international non-governmental organisations have been providing humanitarian assistance to the
population, but their efforts are often disrupted by insecurity.
7
2 BACKGROUND INFORMATION
2.1 Administration:
Each of the administration of Buale and Sakow districts is governed by the district council (21
members) which comprises of a district commissioner appointed by the clan elders; a deputy district
commissioner and 19 representatives from the clans and sub-clans. The district council, religious leaders
and the elders in the district intervene to solve any issues of concern in the districts.
2.2 Security:
Sakow is one of the districts in Middle Juba region mostly affected by the 13 years of civil insecurity,
drought and floods. Civil insecurity as a result of inter clan fighting persisted until 2005 limiting
humanitarian access. The main contentious issue is leadership, which has now been resolved through
appointment of the district council.
The security situation in Buale and Sakow districts is currently relatively calm.
2.3 Nutrition context
In January and March 2006, FSAU conducted two rounds of sentinel sites surveillance mainly among
pastoral and agropastoral communities of Buale, Sakow and Afmadow districts. In each of the sites, a
minimum of 50 children were assessed.
Data from the sites showed high proportions of malnourished children and varying levels of diversity in
the assessed households.
WarengtakneB/Gadud
Tetay Nusduniya Basra
Buale
1 fdgp
2 fdgp
Sako
3 fdgp
Banada
Doble
Jan06
Mar
Jan06
Mar
Jan
Mar
Jan
Mar
Jan
Mar
Jan
Mar
Nevertheless, treatment for severely
malnourished children is unavailable
in the district; the severely
malnourished are referred to MSFBelgium TFC in Marere or Huddur.
Jan
Mar
Proportion of children from households consuming different food groups in sites
in Buale, Sako and Afmadow districts
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Jan
Mar
A supplementary (wet) feeding
program targeting the malnourished
children was and still is managed by
Africa Muslim Aid (AMA), in
Sakow, Salagle, Banada and parts of
Buale and Sakow districts.
B/Qoqani
Afmadow
4+ fdgp
FSAU estimates the long term trend of the nutrition situation in Buale and Sakow districts to be
between 15-19.9%.
UNICEF/WHO are involved with
polio and measles campaigns.
80%
Severe
60%
Moderate
Well
40%
20%
W/takne B/Gadud
Buale
8
Tetay Nusduniya Basra
Sako
Banada
Jan06
Mar
Jan06
Mar
Jan06
Mar
Jan06
Mar
Jan06
Mar
Jan06
Mar
0%
Jan06
Mar
The WVI with support from
UNICEF, manages an MCH /OPD
together with 38 health posts in
Buale. No health facility exists in
Sakow district due to insecurity.
100%
Distribution of children's nutritional status in sentinel sites
in Buale, Sako and Afm adow districts
Jan06
Mar
2.4 Health context
Doble B/Qoqam
Afmadow
2.5 Water and environmental sanitation
Access to safe water for human and livestock consumption has been a major problem in Buale and
Sakow districts, with majority relying on the river as a source.
The World Vision is currently involved in a water and sanitation project and currently undertakes
irrigation and construction of hand dug wells.
Juba Charity Centre is involved in water trucking.
2.6 Education
The Social development initiative organization, a local agency in Sakow town is involved in secondary
school education and has been operational since March 2006. Additionally, SAWA, a local agency
provides adult education services in Buale.
2.7 Food Security Context
Following the failure of Gu and Deyr 2005/06 rains, the sorghum crop in most areas never reached
maturity while pasture and water scarcity has affected the whole district. According to the FSAU
2005/06 Post Deyr Analysis, Technical Series Report No IV. 8, the Middle Juba region has experienced
extremely poor crop production, poor conditions and production of livestock and is faced with a
humanitarian emergency with pockets of livelihood crises (refer to map below). The least affected are
the camels while cattle and shoats more affected by the drought. As a result of the drought and until the
onset of the Gu rains in April 2006, livestock moved within the region in search of pasture and water,
limiting the access of households to milk.
The cumulative effect of drought, poor harvest over years, high asset depletion, population
displacement, and high transportation costs has continuously exposed communities to strains and
stresses and undermined their coping strategies. According to the FSAU Integrated food security and
humanitarian phase classification shown in the figure below, Buale and Sakow districts is in the
Humanitarian emergency with early warning level of moderate risks of famine.
Currently, WFP/WVI provides humanitarian food assistance to vulnerable households.
9
Map 1: Integrated Food Security Phase Classification
10
1.1 JUSTIFICATION FOR THE NUTRITION ASSESSMENT
The persistent food insecurity in the district has deteriorated due to the prevailing drought condition
following the failure of both the Gu and Deyr 2005/06 rains. Consequently, the pastures are depleted
and water shortage problems escalated. Hence a nutrition assessment was important to confirm the
situation of malnutrition levels.
1.2 ASSESSMENT OBJECTIVES
1. To determine the level of malnutrition and nutritional oedema among children aged 6-59 months or
with height/length of 65-109.9cm
2. To determine the level of malnutrition among the women aged 15-49 years in Buale and Sakow
districts.
3. To identify some factors influencing nutrition status of the children in the district
4. To determine the prevalence of some common diseases (measles, diarrhoea, malaria, and ARI) in
the district.
5. To determine the measles and polio vaccination and Vitamin A supplementation coverage among
children in Buale and Sakow districts
6. To assess general feeding and weaning practices in Buale and Sakow districts.
7. To determine the crude and under-five mortality rates in Buale and Sakow districts.
11
3 METHODOLOGY
3.1 Sample size
The target population was children 6-59 months (or heights between 65cm and 109.9cm). In order to
provide valid estimates of the prevalence of malnutrition in children with a 95% confidence level, a total
of 898 children were to be examined using 30x30 cluster sampling.
3.2 Sampling methodology
A two-stage cluster sampling methodology was used. A list of villages with population estimates for all
villages in Buale and Sakow districts was obtained from the WHO, 2005 Somalia polio population
estimates (46,520 for Buale and 87,935) for Sakow) records and confirmed by the community members.
Cluster selection was done during the training session (See Annex 1). Mortality data was collected from
the same clusters.
Household sampling was carried out in the cluster, where the first and subsequent households were
selected. With the help of assessment guides selected by the local authorities, each team went to the
middle of the cluster assigned and determined a random direction by spinning a pencil. The team then
moved to the boundary of the cluster following the direction of the pencil. At the boundary of the cluster
a pencil was again spun and all households along the direction pointed by the pencil were counted and
assigned numbers on a piece of paper. The assessment guide randomly selected the first household to be
visited from the number and the subsequent households were selected by moving to the next household
in the right hand direction from the household exit (door or gate). If the household did not have an
under-five child, teams administered the mortality questionnaire and then moved to the next household
in the right hand direction. All eligible children in each household visited were measured. The MUAC
of the care giver (a mother or woman aged 15-49 years) was also taken. If a caregiver or child was
absent an appointment was made, and the household revisited to examine the child before leaving the
cluster. The missing children were noted in the assessment form though no other child specific details
were collected. If population from the selected clusters had moved, the team followed them to their new
sites and where the population could not be located a cluster with similar charactereristics was used to
replace the originally selected cluster.
Additional qualitative information was collected using focus group discussions and key informants
interviews.
3.3 Quality Control
A comprehensive training of enumerators and supervisors was conducted covering interview techniques,
sampling procedure, inclusion and exclusion criteria, sources and reduction of errors, taking of
measurements, standardisation of questions in the questionnaire, levels of precision required in
measurements, diagnosis of oedema and measles, verification of deaths within households, handling of
equipment, and general courtesy during the assessment. Pre-testing exercise at the field helped in
identifying the enumerators with weaknesses and any question or assessment procedure that was not
clear to both supervisors and enumerators. After pre-testing all the mistakes observed were addressed
and also the teams’ member composition reviewed on the basis of strengths and weaknesses of the
enumerators. Furthermore, supervisors accompanied the enumerators in all households while
administering questionnaires and taking measurements to ensure that standard procedures were
followed. The coordinators also reviewed all questionnaires for any erroneous information on daily
basis.
12
3.4 Variables examined
Age – Only children aged 6-59 months and whose length/height is 65-109.9cm were selected for
examination. The age of a child was determined from the mother/caregiver’s recall, the under fives
growth monitoring card, or from a local events calendar (See Annex 2) in instances where date of birth
was not stated.
Weight: Salter Scale with calibrations of 100g-unit was used. This was adjusted before weighing every
child by setting it to zero. The female children would be lightly dressed before having the weight taken
while clothes for the male children were removed. Two readings were taken for each child, shouted
loudly and the average recorded on the questionnaire.
Height: For height, a vertical or horizontal measuring board reading a maximum of 175cm and accurate
to 0.1cm was used to take the height or length of a child. The child would stand on the measuring board
barefooted; have hands hanging loosely with feet parallel to the body, and heels, buttocks, shoulders and
back of the head touching the board. The head would be held comfortably erect with the lower border
of the orbit of the eye being in the same horizontal plane as the external canal of the ear. The headpiece
of the measuring board was then pushed gently, crushing the hair and making contact with the top of the
head. Height/length was then read to the nearest 0.1cm. Two readings were recorded and the computed
average used in the analysis.
Length: For children aged 6 to 24 months or between 65cm to 84.5cm length instead of height was
taken. The child was made to lie flat on the length board. The sliding piece was placed at the edge of
the bare feet as the head (with crushing of the hair) touched the other end of the measuring device. Then
two readings were taken and the average computed.
Arm Circumference: The Mid Upper Arm Circumference was measured using a MUAC tape to the
nearest 0.1 cm. Two readings were taken and the average recorded for each child.
Women MUAC- Mid Upper Arm Circumference was measured using a MUAC tape to the nearest 0.1
cm. Two readings were taken and the average recorded for each woman aged 18-.49 years.
Oedema – Children were examined for the presence of bilateral pedal oedema. The occurrence of
pitting as a result of thumb pressure on the foot or leg for 3 seconds was indicative of nutritional
oedema.
Diarrhoea – Mothers/caregivers were interviewed regarding any episode of three or more loose, watery
stools in a day, within the preceding two weeks.
Acute Respiratory Infections (ARI) – collected from interviewing the mother/caregiver whether the
child had “oof wareen or wareento” (local term of pneumonia) two weeks prior to the assessment. This
term was validated by further asking if the child had cough, fever and rapid breathing.
Breastfeeding: child having received breast milk within the last 12 hours.
Suspected malaria/acute febrile illness: - collected from interviewing the mother/caregiver whether
the child had malaria two weeks prior to the assessment. Validated by asking the mother if the child had
the following signs; periodic chills/shivering, fever, sweating and sometimes a coma
Measles-the child who had more than three of the following signs was considered to have had measles;
fever and skin rash, runny nose or red eyes and/or mouth infection, or chest infection.
Night blindness- information was collected by asking the respondent to state whether there was any
member of the family who has difficult in seeing at night.
13
Measles immunisation status – the information was obtained by asking the mother if the chid had
received measles vaccination and/or confirmed from the child’s vaccination card.
Polio immunization- the information was collected by asking the caregiver whether the child (aged 9-59
months) had received polio vaccine or and/or counter checking with chid vaccination card.
Vitamin A supplementation - the information was collected from interviewing the mother and recorded
child’s the child’s vaccination card. A Sample vitamin A supplement was used to help the mother in
identification of Vitamin A.
Residential status – In all households visited, the mother/caregiver was asked whether they were
originally resident in the village, or if they were displaced from elsewhere.
Sex of household head – The mother/caregiver was asked to state the sex of the person who makes
decisions regarding welfare of all household members.
Feeding – Introduction of breastfeeding and weaning practices and frequency of feeding children was
assessed by interviewing mother/caregiver to all children.
Dietary diversity -Dietary diversity as household dietary diversity was determined by taking a simple
count of various food groups consumed in a given household over the past twenty four hours.
Public health facilities- health facilities offering health assistance and usually sponsored by
humanitarian organisations, pharmacies and private health services providers
Coping strategies- Information on the frequency of using different coping strategies was collected
Water access-information on source of water, distance to water points, availability of water container,
amount of water used per person per day was sought from the interviewee.
Sanitation- interviewer solicited information pertaining to availability and type of toilet, washing of
hands after defecation or before food handling and use of soap.
MortalityThe overall mortality was calculated by taking the total number of deaths multiplied by a factor
(10,000). This was divided by the population of the assessed households using the formulae below:
CDR= Number of Death
(Total Mid point Population) x Time interval
10,000
Mid Point Population= (Current Population + Population at Beginning)
2
Population at beginning=Current population + Deaths + Number left – Births - Arrivals
14
3.5 Description of activities
Table 3.1: Chronology of activities for the Buale Sakow Districts Nutrition Assessment
Major Activity
2006
Preparation of tools, methodology & review of secondary data (Nairobi)
March 1- April 15th, 2006
Resource mobilization; Joint planning meetings with partners (Nairobi April 1-16th, 2006
and Buale Sakow districts
Training of enumerators, pre-testing and cluster identification
April 22-24th, 2006
Collection of data
April 25 – 27th, 2006
Entry of data in Buale
April 27th – May 1st, 2006
Preliminary analysis in Buale
May 1st- 2nd, 2006
Presentation of preliminary results to the Buale partner agencies
May 2nd, 2006
Further data cleaning and analysis
May 3rd – 15th, 2006
Report writing
May 15- June 12th, 2006
Circulation of first draft report
June 13th, 2006
Circulation of the final report
July 3rd, 2006
3.6 Assessment team composition
Ten teams each consisting of two enumerators and one supervisor conducted the assessment. Each team
handled one cluster in a day. An elder from each particular village/cluster assisted the teams in
identification of the cluster, its centre and boundary. Supervisors were seconded from the participating
partners namely; FSAU and the WVI. The technical coordination was provided by two FSAU senior
nutritionists while the logistical support, enumerators and most of the supervisors (mainly WVI staff)
were provided by the WVI. Additionally, WFP’s national VAM officer and FSAU’s food security
analysts reviewed the food security context.
3.7 Nutrition indicators and cut-offs
Weight for height (W/H)- expressed in Z score - is the most appropriate indicator for quantifying
wasting in a population during an emergency. Weight for height percent of median compares the weight
of the measured child with the median weight of the children of the same height in reference population.
MUAC measures the muscle mass help in determining children at risk of death in emergency. During
data collection W/H was calculated on the sport and the severely malnourished children referred for
treatment. The three modes of expression in the table below were used for presentation of results.
Table 3.2 Nutrition Cut-offs
Nutritional status
Global acute malnutrition
Moderate malnutrition
Severe acute malnutrition
Severe malnutrition
Moderate Malnutrition
Severe malnutrition
WFH in Z-score
WFH % of Median
< -2 or oedema
< 80% or oedema
≥-3 Z-score<-2
≥-70% and <80%
< -3 or oedema
< 70% or oedema
Pregnant women Nutrition Status Cut offs
MUAC<23.0cm
MUAC<20.7cm
Non-pregnant Women nutrition status
MUAC<18.5 cm
MUAC<16.0 cm
MUAC
<12.5 cm
<12.5 cm &≥11 cm
<11 cm
3.8 Data preparation and analysis
During the data collection phase, each questionnaire was thoroughly checked by the field supervisors for
omissions, inappropriate responses and for unlikely weight for height measurements. Pre-coded
responses were entered into EPI Info windows version for data analysis. Data entry was done
concurrently with data collection while addressing any anomalies in the data. Confidence intervals were
used to test for significant differences between prevalence of malnutrition among different age, illnesses,
dietary diversity and social economic factors. Relationship between variable was taken to be statistically
significant if p≤0.05.
15
4 THE ASSESSMENT RESULTS
4.1 Household Characteristics of Study Population
The nutrition assessment covered a total of 898 children aged 6-59 months and 424 women aged 15-49
years from 548 households. The total number of people in the assessed households was 5432 with a
mean household size was 6.049. The household size ranged between 2 to 13 people. The under five
population size was 2031 and a mean size of 2.306 per household (SD=0.03).
Table 4.1.1: Household Characteristics
N
% (CI)
6.04 (SD=0.06)
2.3 (SD=0.03)
Household size (Mean):
Mean No of Under fives
Residence status (N=898)
Residents
Internally displaced
Returnees
Internal Migrant
823
24
48
3
91.6 (89.6-93.3
2.7 (1.8 – 4.0)
5.3 (4.0-7.1)
0.3 (0.1-1.1)
Most (91.6%) of the children
from
the
assessed
households were residents4,
about 5.3% were returnees;
2.7% were IDPs; and 0.3%
were internal migrants. The
non residents were mainly
from within the Lower Juba
region.
Overall the non residents had stayed in their current locations for an average of about 9 months. The
main reasons for movement were related to water and pasture (46.8%) and food shortage/hunger
(38.3%), lack of employment or for civil insecurity.
Table 4.1.2: Livelihood Systems
No
Proportion
Confidence Interval (95%)
Pastoral
Agro pastoral
Urban
Riverine
5.1-8.6
16.4-21.6
18.5-24.0
48.2-54.9
59
167
187
457
6.7
18.8
21.1
51.6
The main livelihood system
in the assessed population
was the riverine, as
indicated in the chart below.
Table 4.1.3: Main source of income
The main source of income for the households is crop sales (61.1%), and casual labour (20%).
Remittances play an insignificant role since the community is resident with few members to the
Diaspora.
No
Proportion
Confidence Interval (95%)
Animal & products
103
11.6
9.6-13.9
Crop sales
544
61.1
57.8-64.3
Petty trade
39
4.4
3.2-6.0
Casual labour
178
20.0
17.4-22.8
Salaried employment 25
2.8
1.9-4.2
Remittances
2
0.2
0.0-0.9
4
Residents were taken as those who dwelt in the places of their residences for an extended period or permanently
16
Water Access and Quality
Most of the assessed children came from households that drew water from unprotected water sources
like the river (48.4%), or unprotected wells (20.4%). Only about 24.8% of the households relied on
water from protected wells.
Table 4.1.4: Water Access and Quality
A lot of time is
spent on water
fetching
with
Main source of drinking water (N=898):
about
43.4%
River
435
48.4 (45.1-51.8)
coming
from
Protected wells, boreholes or springs
223
24.8 (22.1 – 27.8)
households
Unprotected wells
183
20.4 (17.8-23.2)
taking 30 or
Water fetching time (N=898):
more minutes to
54.6 (51.2-57.9)
490
< 30 minutes
and from the
30.2 (27.2-33.3)
271
30 – 59 minutes
water
source
13.9 (11.8-16.4)
125
1 – 2 hours
including waiting
1.3 (0.7-2.4)
12
> 2 hours
time.
Number of clean water containers(N=898)
Households also
62.5 (59.2-65.4)
561
1 - 2 containers
have few and
29.3 (26.4-32.40
263
3 - 4 containers
insufficient clean
7.1 (5.6-9.10
64
5 containers
water storage and
1.1 (0.6-2.10
10
> 5 containers
collecting
containers implying that they require frequent trips to fetch water. About 62.5% of the households have
only 1-2 containers for fetching or storing water. SPHERE (2004) guidelines recommend a minimum of
2 clean containers of 10-20 litres for water collection alone, in addition to enough storage containers to
ensure there is always water in the household.
N
(%)
Sanitation and Hygiene Practices
Majority (50.2%) of assessed children came from households that had no access to sanitation facilities
and used the bush. Traditional pit latrines (16.4%), improved ventilated pit latrines (24.5%) and open
pits (7.7%) were reported as the commonly used sanitation facilities. About 47.8% of the assessed
children came form households in which the distance between area of faecal disposal and water source
was 30 meters or more as recommended by SPHERE (2004).
17
Table 4.1.5: Sanitation & Hygiene
Sanitation and hygiene
Access to Sanitation facility (N=898)
VIP latrines
Traditional pit latrine
Open pit
No latrine at all (Bush)
Distance from latrine to water source (N=508)
< 30meters
≥ 30 meters
Washing agent used in the household (N=898)
Soap
Ash
Plant extracts
Shampoo
None
Method of Food Storage (N=898)
Suspended in hooks/ropes
Put in pots beside fire
Put in covered containers
Don’t store
n
% (CI)
220
147
69
451
24.5 (21.7 – 27.5)
16.4 (14.0-19.0)
7.7 (6.1-9.7)
50.2 (46.9-53.5)
265
243
52.2 (47.4-56.6)
47.8 (43.4-52.3)
491
84
299
5
19
54.7 (51.4-58.0)
9.4 (7.6-11.5)
33.3 (30.2-36.5)
0.6 (0.2-1.4)
2.1 (1.3-3.3)
99
292
293
196
11.0 (9.1-13.3)
32.5 (29.5-35.7)
32.6 (29.6-35.8)
21.8 (19.2 (24.7)
About 54.7% of the
assessed children came
from households that
used soap for washing;
ashes (9.4%); plant
extracts
(33.3%).
About 2.1% came from
households that did not
use
any
washing
detergent at all. The use
of soap or an appropriate
hand washing item e.g.
plant extracts
is a
recommended hygiene
practice that reduces the
chances of ingestion of
dirt and/or faecal matter.
About 21.8% of the
assessed children came from households that did not store any food; and 32.6% from households that
stored food in covered containers while 32.5% from households that stored food in pots besides fire.
Some 11.0% of the children came from households that suspend their food in ropes/hooks. Safe storage
of cooked food (e.g. through covered containers or suspending in ropes/hooks) helps retain cleanness of
the food minimizes contamination with insects. Intake of dirty food predisposes one to diarrhoeal
diseases, a major cause of malnutrition.
Health Seeking Behaviour
Table 4.1.6: Health seeking behaviour
N
Seek healthcare assistance when a
member is sick (N=608):
Yes
No
Where (n=506):
Private pharmacy/clinic
Own medication
Public health facility
Traditional healer
%
506 83.2 (80.0-86.1)
102 16.8 (13.9-20.0)
130
164
103
109
21.4 (18.2-24.9)
27.0 (23.5-30.7)
16.9 (14.1-20.2)
17.9 (15.0-21.3)
self-prescription/medication by their caregivers.
18
Majority of the children who fell
sick during the two weeks prior
to the assessment came from
households that used own
medication (27%), sought health
care assistance from private
clinics/pharmacy(21.4%);
or
sought assistance from public
health facilities (16.9%) while
the rest visited traditional healers
(17.9%) or were administered
Formal and informal support
Table 4.1.7: Formal and informal support
About 42.5% of the assessed
children came from households
that reported having received
some informal support during
three months prior to assessment.
Most of the social support was
mainly in the form of gifts
(17.8%) and remittances from
abroad (9.1%) or from within
Somalia (5.0%).
About 64% of the assessed
children came from households
that reported to have received
formal support, mainly in form of
free food assistance (45.7%), and
water subsidy (8.2%).
N
Informal support (N = 898)
Received:
Yes
No:
Type of support (N=257)
Zakat from better off households
Remittances from abroad
Remittances from within Somalia
Gifts
Loans
Formal support (N = 898)
Received:
Yes
No
Type of support (N=898)
Free food
Veterinary care
Others (animal transport; water)
% (CI)
312 42.5 (29.3-46.9)
516 57.5 (54.1-60.7)
45
82
52
160
43
5.0 (3.7-6.7)
9.1 (7.4-11.3)
5.8 (4.4-7.6)
17.8 (15.4-20.5)
3.5 (3.5-6.5)
575 64.0 (60.8-67.2)
325 36.0 (32.8-39.2)
410 45.7 (42.4-49.0)
31 3.5 (2.4-4.9)
74 8.2 (6.6-10.3)
4.2 Characteristics of the Assessed children
A total of 898 children aged 6-59 months and 424 women aged 15-49 were assessed from 548
households. The household size ranged between 2 to 13 people with mean of 6 and standard deviation
1.792.
Age and gender distribution of children assessed
The summary of the assessed children categorised by age and gender is as presented in Table 2. Out of
898 children examined during the assessment, 420 (46.8%) were boys and 478 (53.2%) were girls, with
a sex ratio of 1:1. The ratio of males to females for the 54-59 age category was lowest with the highest
ratio recorded at 42-53 age category where the number of boys was almost double that of girls.
Table 4.2.1 Distribution of sample by age and sex in Buale and Sakow districts
Boys
Girls
Total
Age in months
No.
%
No.
%
No.
6 – 17
97
10.8
93
10.3
190
18 – 29
129
14.3
162
18.0
291
30– 41
87
9.6
104
11.6
191
42– 53
74
8.2
70
7.8
144
54– 59
33
3.7
49
5.4
82
Total
420
46.8
478
53.2
898
19
%
21.2
32.4
21.3
16.0
9.1
100
Sex
ratio
1 : 0.96
1 : 1.26
1: 1.20
1 : 0.95
1: 1.48
1: 1.14
4.2 Anthropometric analysis
The results of anthropometric analysis were obtained by using weight for height expressed in Z-score or
oedema and percentage of the median of the reference population. The table below shows rates of
children who were severely, moderately malnourished, normal and the total malnourished.
Table 4.2.2 : Distribution of nutrition status
Severe
Moderate
GAM
No %
No
%
No
59
6.6
138
15.4
197
(5.1-8.4)
(13.1-17.0)
%
21.9
(19.3-24.8)
Normal
No
%
701 78.1
(75.2-80.7)
The chat indicates a significant shift to the left, in the levels of acute malnutrition. This demonstrates
deterioration in nutrition situation.
WHZ DISTRIBUTION CURVE
25
Ref erence
Sex Combined
Frequency
20
15
10
5
W/H Z-Score
Table 4.2.3 Distribution of the nutrition status of the children by age
Age Groups Severe (<-3z scores Moderate (<-2 - >3 z Normal (> - 2 z score)
or oedema)
score
No.
%
No.
%
No.
%
6-17 months
12
1.3
36
4.0
142
15.8
18-29
months
30–
41months
42-53
months
54-59
months
Total
18
2.0
50
5.6
223
24.8
8
0.9
29
3.2
154
17.1
12
1.3
17
1.9
115
12.8
1
0.1
8
0.9
73
8.1
51
5.7
140
15.6
707
78.7
20
4.75
3.75
2.75
1.75
0.75
-0.25
-1.25
-2.25
-3.25
-4.25
-4.75
0
About 21.9% of the assessed children were malnourished, using <-2 Z-score or oedema cut-off while
6.6% of the assessed children were severely malnourished, using <-3 Z-score or oedema cut-off. About
15.3% of the children were moderately malnourished. Eleven cases of oedema were identified in the
assessment. The age category 54-59 months had the least number of malnourished children while
highest malnutrition was in age category 18-29 months.
Table 4.2.4 Distribution of children by nutrition status based on Z-score or oedema by sex
Sex
Boys
Girls
Total
≥-2 Z score
No.
321
380
701
%
35.7
42.3
78.1
<-2 and ≥-3 Z score
No.
%
71
7.9
67
7.5
138
15.3
<-3
No.
28
31
59
%
3.1
3.4
6.6
Table 4.2.5 Distribution of children by nutritional status, based on percentage of the Median
6-59 months
Age
Proportion
No
150
Global acute malnutrition
16.7 (CI: 14.4 – 19.3)
111
12.4 (10.3-14.7)
Severe acute malnutrition
4.3 (3.1-5.9)
39
Based on the weight for height as percentage of the median, 16.7.% of the assessed children were
malnourished (WHM<80% or oedema) with 4.4% of the children being severely malnourished
(WHM<70% or oedema). The distribution of the nutrition status of the children by sex basing from
percentage of the median is shown below
Table 4.2.6 Distribution of children by nutrition status based on W/H % of median and or oedema
by sex
Sex
Boys
Girls
Total
WHM<70
No.
%
16
1.8
23
2.6
39
4.3
<=70WHM>80
No.
%
55
6.1
56
6.2
111
12.3
WHM≥80
No.
%
349
38.9
399
42.4
748
83.3
The statistical analysis showed no significance difference between the nutrition status of the boys and
girls by W/H percent of median indicators.
The chronic malnutrition rate based on Height for age, HAZ<-2 was 35.6% (32.5 – 38.9) while
underweight rate based on weight for age, WAZ<-2 was 39.9% (CI 36.7-43.26)
4.3 Children malnutrition by MUAC
The mid-upper arm circumference of the 502 children aged 12 months and above was taken alongside
the height and weight measurements. Basing on the MUAC measurements, 30.6% of the children
assessed were malnourished MUAC<12.5cm/oedema with 7.60% of them being severely malnourished
MUAC<11.0 cm/oedema. The table below summarizes the results.
21
Table 4.3.1 Children (aged 12 months and above) malnutrition rates by MUAC
Malnutrition
Global acute malnutrition MUAC<12.5 cm
Moderate malnutrition <12.5 MUAC≥11cm
Severe acute malnutrition MUAC<11.0 cm
No.
255
Proportion
30.6 (27.6-33.9)
192
23.1 (20.3-26.1)
63
7.6 (5.9-9.6)
4.4 Morbidity, Measles Immunisation, Polio Vaccination and Vitamin A Supplementation
Table 4.4.1: Morbidity, measles immunisation, polio vaccination and vitamin A supplementation
Incidence of major child illnesses (N=898)
ARI within two weeks prior to assessment
Diarrhoea within two weeks prior to assessment
Malaria (suspected) within two weeks prior to assessment
Measles within one month prior to the assessment (N=861)
Immunization Coverage (N=906)
Children (9-59 months) immunised against measles (N=809)
In the past 6 months
Before 6 months
Not immunized
Children who have ever received Polio dose (N= 898)
Yes
– 1 -2 times
– 3 and above
No
Vitamin A supplementation (N= 898)
Children who received Vitamin A supplementation
in past 6 months or before
Children aged 9 months and above with measles vaccination
(n=809)
Micronutrients Deficiencies (N=5439)
Members with night blindness (n=66) in the assessed households
(N=5439):
No.
%(CI)
128
246
238
190
14.3 (12.1 – 16.8)
27.3 (24.5 – 30.5)
26.5 (23.7 – 29.5)
21.3 (18.7 – 24.1
460
290
59
59.9 (53.4 – 60.3)
35.8 (32.6-39.3
7.3 (5.6 – 9.4)
172
549
79
21.5% (18.7-24.5)
68.6 (65.3-71.8)
9.9 (7.9-12.2)
539
68.6 ((65.3-71.8)
750
92.7
66
0.12
The incidences of ARI (14.3%) and diarrhoea (27.3%) within two weeks prior to the assessment were
high but no disease outbreak was reported during the period.
About 26.5% had suspected malaria and the incidence of measles among children in the one month prior
to the assessment was 21.3%.
Measles vaccination coverage for eligible children (9-59 months old) was 92.7%. About 90.1% of the
children aged 6-59 months had received at least a dose of polio vaccine. About 68.6% of the surveyed
children had received Vitamin A supplementation in the 6 months prior to the assessment. Coverage
was relatively high for the three immunizations and supplementation programmes as a result of the
recent campaigns by UNICEF, WHO and local partners.
4.5
Vitamin A Deficiency
About 0.12% (N=66) of the people from the assessed households(Total HH size=5439) were reported to
be faced with night blindness, which is a proxy indicator for vitamin A deficiency. This is within
acceptable levels (Sphere).
22
4.6
Feeding practices
None of the assessed children were exclusively breastfed for the recommended first six months. About
two-thirds (62.2%) of the children aged 6-24 months were breastfeeding at the time of the assessment.
Of those who had stopped breastfeeding, about 11.7% had stopped breastfeeding before six months of
age, 35.9% before their first birthday and the rest (52.3%) within their second year of life.
Table 4.6.1: Children feeding practices
Children aged 6-24 months (N=294)
Is child breastfeeding?
Yes
No
Age stopped breastfeeding (N=524):
Never
1 - 5 months
6 - 11 months
12 – 18 months
> 18 months
Introduction of Complementary feeding
0 - 3 months
4 – 6 months
Over 6 months
Feeding frequency:
Once
2 times
3 – 4 times
5 or mores times
4.7
N
% (CI)
58
236
19.7 (15.3-24.7)
80.3 (75.3-84.7)
2
56
218
152
96
0.4 (0.1-1.5)
10.7 (8.2-13.7)
41.6 (37.4-46.0)
29.0 (25.2-33.1)
18.3 (15.2 – 22.0
121
293
252
18.2 (15.4 -21.4
44.0 (40.2-47.9)
37.8 (34.2 – 41.7
39
187
157
45
10 (7.4-13.7)
48.7(43.6-53.8)
39.8 (34.9-44.9)
1.3 (0.3-5.6
About 18.2% of the children
aged 6-24 were introduced
to foods other than breast
milk early in life between
the time of birth and the
third
month
of
life.
Additionally, about 44.0%
were
introduced
to
complementary feeding at
4-6 months.
About 51% of the assessed
children were fed twice or
less times a day with mainly
cereal-based diets. About
39.8% were fed 3-4 times a
day.
Dietary Diversity
Table 4.7.1: Distribution of dietary diversity among children
No of food groups consumed (N=898)
1 food group
2 food groups
3 food groups
4 food groups
5 food groups
N
20
181
72
208
417
% (CI)
2.2 (1.4 – 3.5)
20.2 (17.6 – 23.0)
8.0 (6.4-10.0)
23.2 (20.5 – 26.5)
46.2 (38.2 -57.6)
Mean HDDS
Main source of food (N=898)
Purchasing
Food Aid
Own production
Bartering
530
133
90
42
59.3 (56.0 – 62.5)
14.9 (12.6-17.4)
10.1 (8.2-12.3)
4.7 (3.4-6.4)
About 30.4% of the
children
came
from
households that consumed
poorly diversified meal
comprising of three or less
food groups, while 69.4%
came from households
consuming four or more
food groups in the
preceding 24hours prior to
the assessment.
Households consumed an
average (HDDS) of 4.35 food groups (SD=1.8) with the number of food groups consumed ranging from
one to 11. Cereal-based diets especially sorghum and maize were the most common. Other food items
commonly consumed were sugar (as tea), oil, meat and beans.
About 59.3%) of the households surveyed mainly obtained their food through purchasing, 14.9% relied
on food aid, 10.1% on their own production and 4.7% relied on bartering.
23
4.8
Adult Malnutrition by MUAC
Table 4.8.1.
Adult nutrition status by MUAC
About 40% of pregnant
women
were
7
2.8
1.1-5.7
malnourished
1
0.4
0.0-2.2
(MUAC<23.0cm) with
8
3.2
1.4-6.2
18.6% severely at risk of
242 96.8
93.8-98.3
malnutrition
(MUAC<20.7cm)
18
18.6
11.4 – 27.7
About 3.2% of non21
21.6
13.9 – 31.2
pregnant women (aged
39
40.2
30.4-50.7
15-49
years)
were
58
59.8
49.3-69.6
malnourished
(MUAC<18.5cm) while 0.3% were at severe risk of malnutrition (MUAC<16.0 cm).
n
%
95% CI
Non Pregnant (N=250)
Severe acute malnutrition (MUAC<16.0 cm)
Moderate risk (MUAC>=16.0 and <18.0
Global acute malnutrition (MUAC≤18.5)
Normal
Pregnant women (N=97)
Severe Risk (MUAC≤20.7 cm)
Moderate Risk (MUAC >20.7 and <23.0
Total at risk (MUAC≤23.0 cm)
Normal
4.9
Relationship Between Malnutrition and Other Factors
Table 4.9.1: Risk factors and relation to total malnutrition (WHZ<-2)
Exposure variable
Child sex: n=898
Male
Female
Age group:
6-24 months
25-59 months
Morbidity patterns
N
(%)
Crude
RR
95% CI
p-value
99
98
23.6
20.5
1.15
0.90 – 1.47
0.30
100
97
25.3
19.3
1.20
1.02 – 1.41
0.04*
23
169
12
88
0.82
0.54 – 1.24
0.409
57
135
24.1
21.5
1.15
0.9 – 1.47
0.31
113
60
21.0
24.5
0.93
0.82 -1.05
0.23
164
28
21.9
14.6
0.91
0.64-1.29
0.67
0.97
0.76-1.26
0.90
0.94
0.66-1.36
0.80
ARI
Yes
No
Diarrhoea: (N=237)
Yes
No
Health programmes
Vitamin A Supplement: N=539
Yes
No
Measles vaccine (N=866)
Yes
No
Dietary & feeding patterns
Breastfeeding (N=239)
Yes
No
Dietary diversity
≤ 3 food groups
≥ 4 food groups
50
83
58
139
21.2
70.6
There is significant statistical between acute malnutrition and age group. This may be attributed to poor
feeding practices of children and infants.
24
QUALITATIVE DATA ON THE FOOD SECURITY SITUATION
BUALE DISTRICT
Rainfall situation
GU rains started in the riverine areas in the south of Buale in the third dekad of March 2006. The
riverine areas in the south of Buale include Banta village to Jiilaalow all the way to Anole in the south
Buale. The heaviest was received Anole down south up to Jiilaalow. The latest rains fell into Buale town
to Buulo-Galool. Though the start of the rains looked below normal in the month of March-April06, a
significant improvement was noted in the first one week of May. This replenished water sources and led
to regeneration of pasture and vegetation in the agro-pastoral and pastoral livelihoods zones.
Crop Condition
The poor households do not have inputs especially seeds, having exhausted it during drought period.
Poor farmers started to lease away their fields to better off households with plans to share the harvest.
Standing crops, mainly sesame and vegetables have been severely attacked by pests (army worms).
Unfortunately, these middle and poor households now have little or no seed stock to replant during the
rainy season and require assistance to replant the destroyed crops.
Food security situation
All livelihoods in Buale experienced two consecutive crop failures GU05 and Deyr 05/06 seasons. The
food stock is depleted as a result. Currently the cereal prices is high in all areas. For instance one bag of
sorghum is currently 250,000 S.Sh for Bu’ale towns market. No local produced cereals available in the
market. Few cereals available remained from previously distributed food aid by WFP in collaboration
with World Vision.
Food sources of poor and middle wealth group of
southern agro-pastoral and reverine livelihoods are
food aid in almost all areas. The poor wealth group
mostly do not have seeds and farmers who managed
to plant faced serious pest armyworm attack, hence
the need for re-plantation. Most of poor and middle
wealth group eat 1-2 times per day.
The food comprises mainly of cereal (cooked maize
flour locally known as Soor) consumed with wild
vegetables such as Ambaqa (refer to the picture).
Consumption of Ambaqa is only done during
extreme food insecurity. Milk is not available in the
market of Buale as camel livestock, which moved to
the area during the drought has moved back to their
origin and hence and higher prices of it.
Income source is limited to few agriculture labour opportunities offered by better off farmers and this is
open to clan affiliated poor households. Though the prospect is that the cycle of drought, which hit the
area of Buale, is ending, it will take few months’ before the community of Buale fully recover from the
effect of the drought. The poor and middle wealthy group continue to depend on food aid before GU
harvest scheduled for August 2006. Qualitative information (key informant interview and focus group
discussion) indicates that coping strategies implored during the drought are now exhausted and there is
a possibility of starvation.
25
Vulnerability ranking
Despite the start of GU in most areas of Buale the effect of drought persists longer due to lack of
previous carry over food stocks and lack of cattle milk production attributed to higher culling rate of
animals (slaughtering younger calves to save the mother cow). Many weak cattle have died during the
onset of the GU rains and due to effect of diseases transmitted by Tse Tse fly.
SAKOW DISTRICT
Rainfall situation
Generally rains started on third dekad of March 2006. Rains fell in all areas except areas starting from
Gomir up to Anole near the border with Dinsor district. Water trucking is ongoing in Rakale and Borrow
where no rains have been to-date. The area between Baarka and Bohosha received only once for the past
45 days. Generally, the rainfall performance is below normal in the district of Sakow. However, in the
first one-week of May 2006, all areas in Juba valley zone including Sakow district received good rains.
Crop condition
The total acreage of crop is below normal. This is linked to labour migration during the drought to areas
outside Sakow and lack of seeds. In the riverine areas, crop planted were limited due to the fear of
possible floods. Lack of seeds/farm inputs of the poor and the middle wealth groups led to the
abandonment of farms and/or renting it to better off households within the community.
Livestock condition
An estimated 80% of cattle died for the past two months for drought related factors. The camel
condition is normal attributed availability of browsing pasture even during the past Jiilaal dry season.
More weak livestock especially cattle died during the onset of the GU rains.
Food market prices
Current cereals prices are the highest compared to the past two years. 1kg of sorghum costs 11,000
because there is no carried-over stock of the past. Limited amount of food aid is available at the market
of Sakow, which according to key informants mainly transported from Salagle with donkey carts. One
mitigated factor could be the availability of Camel milk with reasonable prices i.e. 3,000 S.Sh for 1 litre
of milk in Sakow town. The prices of livestock are low as the body condition is still weak. For instance,
an export quality goat is 200,000 S.Sh while local quality cattle is 1,100,000 S.Sh. The current income
sources of the poor households are primarily collection of bush products and few agriculture labour
opportunities of the starting GU field preparation and planting exercises. A bundle of firewood of
women is 1,000 S.Sh at the market of Sakow while a full donkey cart with firewood ranges between
13,000 S.Sh and 15,000 S.Sh.
Food security situation
Despite Sakow benefiting from irrigation of Juba river, currently there is no carried forward maize
stocks from previous seasons due to the shift of irrigated farmers to fodder production instead of maize
grain production after two consecutive rain failures hit in all agro-pastoral and pastoral areas of Sakow
district. Two early consecutive (Deyr 04/05 and GU06) seasons of non-food cash crop production e.g.
sesame also contributed the early depletion of food stocks within the districts.
Food consumption varies by livelihoods and by wealthy groups. The body condition of the remaining
cattle is improving.
Remittance is very limited in the area of Sakow as the community here did not flee the homeland for the
past 15 years and therefore majority do not have relatives in Diaspora. All poor & middle wealth groups
26
do not have stocks at the moment and mainly depend on purchase of what remained from cereal food aid
distributed in March 2006 by WFP especially the late food aid being distributed in Salagle. No major
disease outbreak is reported in Sakow. However, due to lack of provision of health services and
according to discussion with the community there is high prevalence of certain diseases such as malaria,
diarrhoea, dysentery, and conjunctivitis. Schools have been closed in the district due to high dropout
attributed to the drought.
Majority of the poor and middle wealth group of all livelihoods eat 1-2 meals per days composed of
mainly cereals with hardly additives. No diversity foods available and fish is not available in Desheks as
it was dry and just refilled by the current onset of GU rains.
There are limited agricultural labour opportunities not open to everybody, but rather based on clan or
relative affiliation.
The vulnerability ranking
Though, the drought effect has been felt across all livelihoods in the district, the Southern agropastorals and riverine livelihoods groups are most vulnerable in the Sakow district due to depleted
household stocks during the successive rain failures.
27
4.10 MORTALITY
The retrospective mortality assessment was done co-currently with the nutrition assessment in 30
selected clusters. All households in the selected clusters were eligible for the administration of the
mortality questionnaire irrespective of whether or not they had under-five. A total of 927 households
were assessed and the retrospective mortality rates calculated on the basis of recall period of 93 days
from January 23rd, 2006 – April 24th, 2006. Data was entered in Epi info and mortality rates calculated
using the formulae below.
i). Crude mortality rate (CMR)
CMR= Number of Death
(Total Mid point Population) x Time interval
10,000
Mid Point Population= (Current Population + Population at Beginning)
2
Population at beginning=Current population + Deaths + Number left – Births - Arrivals
Number of deaths=29
Current Population=5083
Number of those arrived (Arrivals) =6
Number that left= 202
Number of Births=61
Time interval=93 days
CMR =0.61 deaths/10,000 persons/day (CI: 0.39 – 0.83).
Basing from the WHO categorization, the CMR of Buale Sakow districts is within acceptable levels.
ii). The Under five mortality rate (U5MR)
U5MR= Number of Death of under-five
(Mid point population of under-five) x Time interval
Mid point population of under-five= Current population of under-five+ Population of under-five at
beginning
2
Population at beginning of recall = (population present + left + deaths) – (joined + births)
Number of death of under-five=29
Current population of under-five=1589
Number of under-five that left=16
Number of Births=61
Time interval= 93 days
Number of under-five that arrived=6
U5MR=1.98/10,000/day (CI:1.26 – 2.69)
Basing from the WHO classification, the U5MR of Buale Sakow of approximately 1.53 deaths/ 10,000
persons per day indicates an acceptable situation.
The main causes of deaths were diarrhoeal diseases: 2.0% (17 cases), malaria: 1.2% (10 cases), birth
complications: 0.8% (7 cases) and to HIV/Aids 0.6% (5 cases) to HIV/Aids. Other causes of death
reported included measles and ARI.
28
5 DISCUSSION AND CONCLUSIONS
Nutrition Status
Findings indicate a global acute malnutrition rate (weight for height <-2 Z score or oedema) of 21.9%
(CI:19.3-24.8) and severe acute malnutrition (weight for height <-3 Z score or oedema) of 6.6% (CI:5.18.4). This highlights a critical nutrition situation (WHO) which is worsening when compared to long
term estimates of malnutrition (15-19.9%) for the area. Additionally, about 40% of the 97 assessed
pregnant women had MUAC < 23.0 cm, while 3% of the 250 non-pregnant women had MUAC
<18.5cm and were categorized as malnourished.
Retrospective Mortality
The crude mortality rate was 0.61 (CI: 0.39 – 0.83) deaths/10,000/day and the under five mortality rate
1.98 (CI:1.26 – 2.69) deaths/10,000/day which are acceptable (WHO categorization).
Child care related issues
About 38% of the children were introduced to complementary foods at the age of 6 months which is the
recommended age. Thus, majority of the children (about 62%) were introduced to foods either early or
later in life, a sub-optimal feeding practice that could lead to poor nutrition situation. About 51% of the
assessed children were fed twice or less times a day with mainly cereal-based diets which is also a suboptimal practice (a minimum of 4 feeds that are diverse in nutrients is recommended).
There was a statistical significance (p<0.04) between malnutrition and the age group with the 6-24
months category being more likely to be malnourished. This is usually the critical and vulnerable age
among the under fives at which children are breastfed and introduced to other complementary foods.
Sub-optimal feeding practices like inadequate breastfeeding practices, less frequent feeds as well as poor
quality of the foods negatively impact on the nutrition status of the children.
The relatively high measles immunisation and vitamin A supplementation coverage serves as good
mitigating factor to a poor nutrition situation and is associated with a recent measles immunisation
campaigns.
Morbidity
Diseases and children’s nutritional status exhibit a vicious cycle relationship. Sick children will usually
suffer anorexia reducing food intake while food absorption is also compromised ultimately predisposing
the children to poor nutrition. Likewise, malnourished children are more prone to diseases as their
body’s immune system is low. About 49% of the assessed children reported to have suffered from an episode
of a communicable disease in the preceding two weeks. The high morbidity may be associated both to
endemic diseases and limited access to health care services, particularly in Sakow where there is not a
single health facility. The prevalence of diarrhoea (27%) and malaria (26%) in the two weeks prior to
the assessment were particularly high and may have contributed to the critical nutrition situation.
Additionally, about 75% of the children came from households which consumed water from unsafe
sources (the river, unprotected wells or water catchments) and about 50% came from households that
dispose off faecal matter in the bush. Consumption of unsafe river water is a possible cause of diarrhoeal
infections and subsequent malnutrition.
Dietary diversity
About 30.4% of the children came from households that had consumed meals from three or less food
groups (based on FAO classification), while about 69.6% came from households consuming a more
diverse diet of four or more food groups in the previous 24 hours. Cereal based diets especially
sorghum and maize were the most common. Other food items commonly consumed were sugar and oil.
29
Previous studies have indicated an association between malnutrition and dietary diversity. A significant
proportion of children consumed a less diverse diet of less than four food groups in this study, which
could have contributed to acute malnutrition.
Qualitative Data
Qualitative data indicates poor household food access due to high food prices, and general unavailability of animal
products, most of the livestock having either died, migrated back to areas of origin or, in too poor body condition
to provide milk and milk products. The food stocks are also exhausted and the population groups coping strategies
have almost collapsed. Limited access to food may have contributed to poor dietary intake and subsequently acute
malnutrition.
Mitigating Factors
Mitigating factors include vitamin A supplementation (69%) and measles vaccination coverage (about 93%)
attributed to the recent immunization campaigns in Buale and Sakow districts. Nevertheless these are below the
SPHERE minimum recommendation of 95%. About 64% of the children came from households accessing formal
humanitarian support in the preceding three months, mainly in the form of food assistance (about 46%) in February
2006; and informal humanitarian support, mainly in the form of gifts (about 43%). On-going humanitarian
interventions which may also have mitigated the nutrition situation include: food assistance by the WFP/WVI,
health care services and a water and sanitation program in Buale by the World Vision and supplementary feeding
by the African Muslim Aid (AMA).
6 CONCLUSION AND RECOMMENDATIONS
The global acute malnutrition (weight for height <-2 Z scores or oedema) of 21.9% depicts a critical
nutrition situation in Buale and Sakow districts. Limited access to food, high morbidity and poor child
care practices are among the underlying factors contributing to the critical nutrition situation. The crude
mortality rate of 0.61/10,000/day and the under five mortality rate of 1.98/10,000/day are however
within acceptable levels (WHO categorization).
Following presentation and discussion of assessment findings with partners, the following
recommendations were made:
Short term recommendations:
i)
Increased access to food (both the short and longer term interventions).
ii)
Continuation and intensification of health, water and sanitation interventions especially
immunization programs, rehabilitation and protection of water points and provision of
sanitary facilities
iii)
Rehabilitation of cases with severe malnutrition.
Long-term Recommendations
i)
As high levels of malnutrition have been seen throughout the camps, it is recommended that
the local MCHs / local health personnel are equipped with the knowledge and skills to
manage severe malnutrition both during and outside periods of crisis.
ii)
Improve access to quality for medical care through establishment of a clinic or hospital in
Buale Sakow districts.
iii)
Health/nutrition education for the population focusing especially on appropriate child
feeding practices and management of diarrhoeal diseases.
iv)
Establish projects geared towards livelihood recovery
7 APPENDICES
30
7.1
APPENDIX 1: Population Estimate for Buale and Sakow Districts
S.# Village/Town
1 Buale
2 Gobate
3 Sukeyla
4 Qardhale
5 Canole
6 J.Kore
7 Dal-la-helay
8 Dalxis
9 Sakow
10 Arbay
11 Nebsoy
12 Birbiriso
13 Gurmayso
14 Dodey 1
15 Bar M Dhorow
16 Nusduniya
17 Kurawo
18 Sako Yare
19 Qayd Cajuz
20 Basra
21 Qaboobe
Population
Cumulative
7500
1550
810
635
900
605
600
450
13050
12000
725
750
750
1800
400
1500
1000
700
700
900
800
400
Clusters
7500 1,2,3,4
9050
10460
11970
14035
15590
16790
18840
5
6
7
8
9
10
11
32040 12,13,14,15,16,17,18
32765
33815
36215
38345
39295
41695
42695
44740
46080
48080
49480
51230
19
20
21
22
23
24
25
26
27
28
29
30
Inaccessible areas due to sludgy or muddy roads – omitted from the sampling frame
1 Qararey
545
2 Bidi
435
3 Afgoye
455
4 Kaskey
445
4 Farbito
1000
5 Manane
645
6 Shingani
710
7 Hurufle
600
8 Arabow
400
9 Kurtun
400
10 Kafinge
490
11 Qoryale
500
12 Bilweyn
200
13 Raxole
845
14 Waregta Hose
505
22 Gomir
15 Jirmo
300
23 Bagaday
16 Cilmi
600
24 Ashirow Lizan
17 Markanbka
300
25 banada
18 Booho
250
26 Aliyow kerow
19 Bulo Idow
600
27 Galagal onle
20 Somba
250
28 Gololey
21 A.Arbow
950
31
1200
605
485
3000
400
2500
800
Table of Random Numbers
Range: 1 to 500, Number: 500
449
77
225
383
382
371
436
213
239
104
92
171
96
346
41
313
422
406
317
194
363
221
283
128
201
329
202
417
375
146
55
349
222
325
291
75
413
100
210
265
102
403
73
111
320
488
71
190
17
367
33
158
308
306
343
65
57
172
432
229
390
43
16
152
58
388
3
126
29
386
129
442
334
276
293
36
438
18
354
214
116
46
255
347
286
94
297
141
258
472
441
464
471
105
327
127
169
189
323
1
12
500
163
256
372
4
421
439
282
101
233
123
238
167
208
315
136
285
30
211
322
395
414
416
348
67
338
84
145
212
186
254
103
199
69
85
341
358
493
132
115
326
498
480
443
474
384
19
164
40
451
122
324
402
5
461
391
356
68
381
278
277
463
309
7
462
468
424
409
264
453
430
447
419
230
64
114
339
396
379
290
300
301
466
244
407
260
467
305
302
287
359
20
34
374
487
150
392
385
311
44
227
87
477
98
316
32
165
236
109
215
35
262
331
134
458
271
196
70
61
292
247
184
117
364
249
8
51
427
270
246
484
232
151
295
353
481
181
237
119
437
179
82
137
83
166
162
465
445
120
252
216
32
133
180
378
263
121
235
205
337
131
429
272
62
248
494
380
174
482
446
191
456
342
118
350
408
361
469
78
23
22
38
154
81
360
2
435
352
91
399
479
476
59
95
410
431
304
434
149
60
280
310
47
142
365
444
52
31
90
269
333
412
448
147
9
257
321
14
124
450
267
206
72
377
195
204
397
155
401
426
398
387
99
177
294
176
440
273
261
298
159
489
45
420
63
373
170
423
303
499
259
217
107
288
470
319
130
318
351
289
153
454
66
56
108
345
27
281
6
241
335
279
433
425
376
460
240
54
457
28
224
97
340
148
21
495
168
485
187
188
37
203
268
157
25
231
459
220
135
428
125
110
219
182
76
266
86
490
250
197
491
366
389
193
207
49
173
452
415
483
330
80
492
89
251
13
113
234
53
24
218
144
226
393
198
161
139
370
473
50
253
175
209
357
400
362
10
183
314
418
478
369
275
411
15
336
200
296
223
404
475
368
284
497
74
496
143
332
112
486
245
355
455
242
42
185
228
178
140
160
79
26
328
344
243
312
405
394
192
39
274
11
156
88
299
138
307
106
48
7.2
APPENDIX 2: Traditional Calendar
Districts
2001
2002
52
January
Carafo
51
February
Sakow
March
April
May
For Nutrition Assessment In Buale And Sakow
2003
40
Carafo
39
Sakow
50
Safan
49
Mawlid
RabiculAkwal
38
Safar
37
Mawlid
Rabicul Awal
48
Malmodone
RabiculAkhir
36
Iraq War
Malmodone
Rabicul
Akhir
35
Jamadul
Awal
34
Death of
General
Gabyoo
June
59
Jamadil Awal
47
Jamdul Awal
July
58
Jamadil
Akmir
46
RRA fighting
in Baidoa
-jamadul
Akhir
33
Rajab
32
Shacban
57
Rajab
56
September 11
Shacban
45
Rajab
44
Shacban
October
55
Soon
43
Soon
31
Soon
Death of
former Buale
DC
November
54
Soonfur
30
Soonfur
December
53
Sidataal
42
Buale
Fighting
-Soonfur
41
Sidataal
August
September
29
Sidataal
33
2004
28
Carafo
27
Sakow
Sakow market
burnt
26
Safar
25
Mawlid
Rabicul Awal
24
Malmo=done
Rabicul Akhir
23
Jamadul Awal
22
Jamadul Akhir
21
Rajab
20
Shacban
-World Vision
moved from
Buale
- Buale
reconciliation
meeting
19
Election of
Somali
President
Abdulahi
Yusuf
18
Good deyr
rain
Soonfur
17
Sidataal
2005
16
Carafo
15
Sakow
14
Safar
13
Riverine
floods
- Mawlid
Rabicul Awal
12
Rabicol Awal
Malmodone
11
Jamadul
Awal
10
Jamadul
Akhir
9
Rajab
8
Shacban
7
1st food
distribution
by WV
6
Soonfur
7.3
APPENDIX 3: Mortality Questionnaire
Household No: _____
No. 1: First Name
Date: _______ Team No: ____ Cluster No: ____ Enumerator’s Name: ____________
2: Sex
6: Reason for
7: Cause of
3: Age
4: Born since 21st 5: Arrived since
(1=M;
October 2005
21st October
leaving
death
(yrs)
2=F)
2005
a) How many members are present in this household now? List them.
b) How many members have left this household (out migrants) since 1st June 2005? List them
c) Do you have any member of the household who has died since 1st June 2005? List them
Codes
Reason for migration
1= Civil Insecurity
2= Food Insecurity
3= Employment
4=Divorce
5=Visiting
Cause of death
6= Other, specify
1= Diarrhoeal diseases
2= ARI
3= Measles
4= Malaria
5= HIV/AIDS
6= Anaemia
7= Birth complications
8= Other, specify
Summary*
Total
Current HH Members
Arrivals during the Recall period
Number who have left during Recall period
Births during recall
Deaths during recall period
* For Supervisor Only
34
U5
7.4
APPENDIX 4a : Nutrition Assessment Questionnaire Somali version
Tariikh_________________ Lambarka Kooxda__________ Lambarka Goobta___________ Magaca Kormeeraha______________________ Magaca Degmada_____________
Magaca Tuulada/Magalada____________ Magaca Qaybta______________ Lambarka Qoyska______________
S1-14 Dabeecadaha Qoyska
S1
S2
S3
S4
S5
S6
S7
Muxuu yahay jinsiga madaxa qoysku? 1= L
2= Dh
Imisa qof ayaa qoysku ka kooban yahay ( tirada xubnaha qoyska)? ______
Imisa Carruur 5 sano ka yar ayaa u jooga qoyska ( Tirada 5 sano ka yar) ______
Xaaladda Degannaanta qoysku waa noocee? 1 = Degaan joogto ah 2= Gudaha ku barakacay 3= Soo laabtay 4= Gudaha ka soo hayaamay 5 = Nooc kale, caddee
Intaadan halkan degin xaggee awal ka timid? ( Degaankaaga asalka ah
Halkan imisaad ku noolayd? _______
Maxay ahayd sababtaad halkan u timid? _______
( waxaad xulan kartaa in kabadan hal mid haddii ay habboontahay 1= Amnaan darro 2= Shaqo la’aan 3= Cuntoyari 4 Biyo yari
S8 Shayga ugu muhiimsan ee noloshiinu ku tiirsan tahay waa kuma? 1) Xoolo 2) Beero-xolaleey 3) Xoogsi 4 ) Beeraha waraabka, 5 ) Ganacagsi yar yar , 6) Mush,haari ah, 7) iibka dalaga, 8)
iibka Xoolaha iyo wax soo saarka xoolaha 9) xawaalad/Sadaqo
10 ) Nooc kale; caddee-----------------------S 9-11 Kaladuwanaanta cuntoyinka (Dietary Diversity)
Xusuusashada cuntadii qoysku isticmaalay 24kii saac ee tagtay. Waraystuhu waa inuu caddeeyo in shalay ay caadi`u ahayd qoyska iyo inkale. Hadii ay jireen Alle-bari (Walimo), Duug ama
xubnaha inta badani maqnaayeen, kolka maalin kale waa in la doorta sida dorraad. Ama beddelkeed dooro qoys kale
S9
Rashin nocee ayay isticmaleen dadka
qoyska tirsan ka bilabato marka la
soo kacay shallay subax?
Imisa jeer ayay rashinka cuneen dadka
qoyskan katirsan?
(kudar isticmalka cabitaan iyo caannaha
naaska)
0=maya 1= mar 2= laba
3=3 saddex 4=4 jeer
5=5 ama in kabadan
Nooca da Cuntada
Inta jeer
(<5yrs)
1.
2.
3
4
5
6
Inta jeer >5yrs
Tirade guud ee noocyada cuntada iyo kooxaha la isticmaalay
S-10 iyo 11{Waxaa buuxinaya kormeeraha }
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Firaley (Bariis, Qamadi, Basto, Badar, Gelley, Canjero, Bur)
Digirta iyo qolofleyda kale
Caano(milk)
Kalluun/cunto badeed
Hilib iyo ukun
Sokorta Shaaha iyo tan kaleba
Dufan/Saliid/Subag
Xididaley/buruqley( Bataati
Miro
Khudaar
7
S 10-Tirade noocyada cuntada ?
S11 TIirada kooxaha cuntada ?
S12. Intabadan rashinka laga isticmalay guriga intuu inka soo gallay? 1=Xoolaha/dhalaga beerta 2=Soo iibsasho
5=ku doorsasho
6=Amaah
7=Qaraan
8=kuwa kale (caddee) ________________
3=Siismo saxiib/qarabo
4=Raashin gargaar ah
S13-23 Cudurrada, Quudinta & xaaladda tallaal ee ilmaha jira 6 -59 bilood ( ama 65-110 cm) dherer le’eg ee jooga guriga
Tirsi
Magac
S13
Shuban 2dii Usbuuc
ee tagtay
S14
Ofwaren
2-dii
usbuuc
ee tagtay
S15
Duumo
2-dii
Usbuuc
ee
tagtay?
S16 (9-59
Billood)
Jadeeco
bishii
tagtay?
S17 (9-59
S18
S19
S20
Billood)
Lixdii bilod
ee
tagtay
mala siiyey
Vit A ? ( tus
kabsol-ka)
Ilmaha
Naasaha
ma
nuujisaa
hada
Haddii aanu
naasaha nuugin
imisuu jirey marki
laga
guriyey/gooyey?
Ma laga tallaalay
Jadeeco
1= Haa
0= Maya
1=Haa
0=Maya
1=Haa
0=Maya
1=Haa
0=Maya
1=Haa
0= Maya
1=Haa
0=Maya
1=Haa
0=Maya
1= ka yar 6 bilod
2= 6 – 11 bilood
3=12 – 18 bilood
4=18 bilood ama ka
badan
5= Weligii lama siin
S21
Imisuu jirey
ilmuhu markii
la siiyey cunto
iyo cabbid aan
ahayn
caanaha
naaska?
1=0-3 bilood
2=4-6 bilood
3=7 bilood
ama ka badan
S22
Malinti
imisa jeer
ayaad
quudisa
ilmaha?
1= Mar
2= Laba
3= 3-4 jeer
4= 5 ama
ka badan
S23
Weligi inte
goor
tallaalka
dabaysha
afka laga
siiyey
1=1-2 jeer
2=3 &
kabadan
3=Marna
1
2
3
S24
S25
majiro
Marki ilmuhu kaa jirrado, halkee gargaar caafimaad ka raadsataa? 1-Dawo dhaqameed 2=Bar caafimad gaar loo leyahay/Farmashi 3= Baraha caafimaadka bulshada 4= Meel kale, caddee
5=Ma xanunsan
Ma jiraa qof dadka qoyska ka mid ah oo araggiisu liito habeenkii ama fiidki iyadoo dadka kale caadi wax u arki karaan? 1 = Haa 2-6 Sano= 2=haa ka badan 6 Sano
S26 – 33 jir cabbirka ilmaha jira 6- 59 bilod ( ama 65-110cm) ee qoyska ka mid ah
36
3=Mayo
Tirsi
Magaca
Kowaad
S26
Jinsi
1= (L)
2=(Dh)
S27
Da’da
oo’ bilo
ah
S28
Barar
S29
Dhererka
(cm)
S30
Culayska
(kg)
1=Haa
0= Maya
S31
Dhexroork
a
Bartamaha
Cududda
Sare
(MUAC)
(cm)
S32
Dhereka
Bartamaha
\Cududa
MUAC
{Cm}
S33
Xaalada
\Daryeellaha
12-
1
2
3
37
Uurey
Uur Lahayn
S 34. Isticmaalka xeeladaha isdebiridda (Consumption Coping Strategies)
Soo noqnoqodka isticmalka
0= Marna Lama isticmalin (0 jeer usbuuciiba )
1= Mar dhif ah(< 1 mar usbuuciiba)
2= Marmar ( 1-2 jeer usbuuciiba )
3= Inta badan (3-6 jeer usbuuciiba)
4= Markasta( Maalin walba)
S34 30 Kii casho ee tagtay haddi ay jirtey xilli aydaan haysan lacag aad ku iibsataan ama
raashin idinku filan inta badan maxaa la samayn jirey
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
In laga tago cuntada tayada leh lana isticmaalo cunto jaban oo tayadeedu lidato
In cunto la soo deynto ama lagu xirnaado kalmo laga helo saaxiibo ama qaraabo
Cuntada in deyn lagu soo qaato
Duurka in qaraabasho ama ugaarsi loo doonto
Xoolaha in lagu iibsado qiimo xooris ah si raashin loogu beddesho
Xubnaha qoyska in loo diro inay meelo kale wax ka soo cunaan
Xubnaha qoyska in tuugsi loo diro
In la yareeyo xaddiga cuntadii la karsan jirey markiiba
Cuntada dadka waaweyn in laga xannibo si ilmaha cuntada loogu quudiyo
Raashin diyaarsan in suuqa laga soo gato
In la yareeyo intii jeer maalinti wax la cuni jirey
Maalin dhan inaan dab la shidan
In la baabi’iyo hantida si raashin loo helo : in la gado Xoolo, Dhul ama dahab
in hantida dammaanad ahaan loo isticmaalo sida Berkad ama Dahab si raashin loo helo
Q35 - 40 Helitaanka Biyaha Aadamigu isticmaalo (Tayo ahaan iyo tiro ahaan - quality and quantity)
S 35 Isha ugu muhmsan ee biyaha la cabbo 1= tuubo guriga toos u keenta biyo 2= Qasabadaha dadweynaha ka dhaxeeya 3= tubo ceel hoos u qodan 4= Ceel lama il burqanaysa oo la xafiday 5=
Ceel am il aan la xafidin 7 webi 8= kale
S36 isha ugu muhimsan ee biyaha karinta iyo nadaafadda jirka 1= tuubbo guriga toos u keento biyo 2= qasabadaha dadweynaha ka dhaxeeya 3 Tubo ceel hoos u qodan 4 il burqanaysa ama ceel
la xafiday 5 biyo roob 6 il iyo ceel aan xafidnayn 7 wax kale cadee-----------------------------S 37 Biyaha qoysku maalintii u isticmalo cabid, karsi iyo nadaafadda dadka 1= <20 litir
2= 20-60 litir
3= 60-120 litir
4= >120 litir
S38 Masaafada barta biyaha ee ugu dhow 1= 0-500 tallaabo 2= 501-1000 tallaabo 3= 1001-5000 talaabo 4= ka badan 5000 tallaabo
S39 Biyaha iyo habka lagu helaba waa la ilaaliyey si joogto ah sidaas darteedna waa la heli karaa intii looga baahnaa 1= Marna 2= marmar 3= inta badan mar kasta 4 =Mar kasta
S40Tirada weelasha biyaha si nadiif ah loogu kaydsado ee qaada 20 litir 1= 1-2 Caag 2= 3-4 Caag 3= 4-5 Caag 4= ka badan 5= Caag
S41-47 Fayadhawrka iyo Nadaafadda ( u sahlanaanta iyo tayada - access and quality)
S41 Nooca Musqusha xubnaha qoyska inta badani isticmalan 1=Musqul god leh oo habaysan( saxan leh) 2= Musqul caadi ah 3= God af bannaan 4= Bannaanka 5= Wax kale ( tilmaan)
S42Tirada dadka halkii musqul isticmaasha 1=1-5 2= 6-10 3= 11-15 4= 16-20 5= ka badan 20 qof 6= kuma haboona
S43 Dadka gurigu markay saxaroodaan ka dib faraha ma dhaqdaan 1= Mar kasta 2= inta badan 3= marmar 4= Dhif iyo nadir
S44 Dadka gurigu ma gacmo dhaqdaan intaan wax la cunin ama xilliga diyaarinta cuntada 1=badanaa 2= inta badan 3 =marmar 4= dhif iyo nadir
S45 Qoyska miyu haysta sabuun?
1=Haa
0=Maya
S46 Xubnaha qoyska ma isticmalan sabuun ay ku gacma dh’aqdaan sharada kadiib ii goorta rashinka ladiyarinayo?
1 =Haa
S47 Masaafada ay isu jiran musqusha iyo isha biyaha
4= 21-29 talaabo 5= 30 tallaabo iyo ka badan
1= 0-5 tallaabo
2= 6-10 tallaabo
38
3= 11-20 tallaabo
0= Maya
7.5
Appendix 4b: BUALE AND SAKOW NUTRITION ASSESSMENT QUESTIONNAIRE-English version
BUALE/SAKO DISTRICTS NUTRITION ASSESSMENT, APRIL 2006
HOUSEHOLD QUESTIONNAIRE
Date_______________
Team Number ______
Cluster Number _______________________
Name
District ____________________ Household Number ______
Name
of
enumerator
__________________
Name of Village/Town ______________________
of
the
Respondent
_______________
Q1-8 Characteristics of Household
Q1 How many people live in this household (Household size)5 ?__________
Q2 How many children are below five years in this household (Number of < 5 years)? ____________
1= Resident6
Q3 What is your present household residence status?
__________
If answer to the above is 1, then move to Question 7.
2=Internally displaced7
3=Returnees8
4=Internal immigrant9
5=Other (specify)
Q4 Place of origin (categorize during questionnaire design) __________________
Q5 Duration of stay ______________________
Q6 Reason for movement: 1= Insecurity
2=Lack of jobs
Q7 What is the livelihood systems used by this household? 1= Pastoral
Q8
What is the household’s main source of income?
3= Food shortage 4=Water shortage
5=Others; specify_______________________
2=Agro- pastoral
4= Riverine (irrigated agriculture; fishing)
1= Animal & animal product sales
5= Salaried employment
3=Urban
2= Crop sales
6= Remittances
3= Petty trade
4= Casual labour
7= Other, specify ____________________
Q9-16 Feeding and immunization status of children aged 6 – 59 months (or 65 – 109.9 cm) in the household.
5
Number of persons who live together and eat from the same pot at the time of assessment
A person who dwells in a particular place permanently or for an extended period
7
A person or groups of persons who have been forced or obliged to flee o to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed
conflict, situations of generalized violence, violations of human rights, or natural or human-made disasters, and who have not crossed an internationally recognized State Border" source, guiding
principles on internal displacement
8
Refugees who have returned to their country (Somalia) or community of origin, Somalia, either spontaneously or through organized repatriation [ UNHCR definition]
9
A person who moves (more or less permanently) to a different administrative territory due to a wide range of reasons (e.g. job related, security)
6
39
Sn
o
First Name
Q9
(If
6-24
months)
Are
you
breastfeeding
10
the child?
(if no, skip to
Q14)
1=Yes
2=No
Q10
Q11
Q12
If breast
feeding, how
many
times/day?
If not breast
feeding, how old
was the child
when you stopped
breast-feeding?
At what age was
child given water/
foods other than
breast milk
1=<3 times
2=3-6
3=On demand
1=<6 months
2=6-11 months
3=12 – 18 months
4=≥18 months
5= Never
breastfed
Q13
How many times do
you feed the child
in a day (besides
breast milk)?
1= Once
2= Twice
3= 3-4 times
4= 5 or more times
1=0-3 months
2=4-5 months
3=6 months or
more.
1
2
3
4
Q17-27 Anthropometry and morbidity for children aged 6 – 59 months or (65 – 109.9cm) in the household
10
Child having received breast milk either directly from the mothers or wet nurse breast within the last 12 hours
40
Q 14
Has child been
provided
with
Vitamin A in the
last 6 months
(show sample)
1=Yes
2=No
Q15
(If ≥9 months old)
Has child been
Vaccinated against
measles?
1=In past 6 months
2=Before 6 months
3=None
Q16
How many
times has the
child ever been
given polio
vaccine orally
1=1-2 times
2=3 and above
3=Never
Sno
Q17
Q18
Q19
Q20
Q21
Q22
Child
Sex
Age in
months
Oedema
Height
(cm)
Weight
(kg)
MUAC
(cm)
First Name
As
per
table
on
page
1
1=Male
2=Femal
e
Q23
Diarrhoea11
in last two
weeks
Q24
Serious
ARI12 in
the
last
two weeks
1=yes
2=no
1=Yes
2=No
1= Yes
2= No
Q25
Febrile
illness/
suspecte
d
Malaria13
in
the
last two
weeks
1=Yes
2=No
Q26
(If ≥9 month)
Suspected
Measles14 in
last one month
1=Yes
2=No
Q27
[Applicable for a child
who suffered any of the
diseases in Q23 – 25
Where did you seek
healthcare assistance
when (Name of child)
was sick?
1=No assistance sought
2=Own medication
3=Traditional healer
4=Private
clinic/
Pharmacy
5=
Public
health
facility
1
2
3
4
28: Anthropometry (MUAC) for adult women of childbearing age (15-49 years) present at the household
Sno
Name
1
Mother:
Age (years)
MUAC
Physiological status
1=Pregnant
2=Non pregnant
Illness in last 14 days? If yes, what illness?
2
3
Q29
Does any member of the household have difficulty seeing at night or in the evening when other people do not? 1= 2- <6 years 2= ≥ 6 years 3= None
11
Diarrhoea is defined for a child having three or more loose or watery stools per day
ARI asked as oof wareen or wareento. The three signs asked for are cough, rapid breathing and fever
13
Suspected malaria/acute febrile illness: - the three signs to be looked for are periodic chills/shivering, fever, sweating and sometimes a coma
14
Measles (Jadeeco): a child with more than three of these signs– fever and, skin rash, runny nose or red eyes, and/or mouth infection, or chest infection
12
41
Q30-33 Access to water (quality and quantity)
Q30 Main source of drinking water 1 =piped 2= Unprotected well
3= Water catchments
4= Protected well, boreholes or spring
5 = River
9=other
____________
Q31 Average time taken to and from the nearest water point (including waiting and collecting time)
1= <30 min
2=30 – 60 min 3= 1-2 hrs
4=
more
than 2 hrs
Q32 Number of water collecting and storage containers of 10-20 litres in the household: 1=1-2 containers
2= 3-4 containers
3=4-5 containers 4=
more
than 5
Q33 What is the method of water storage in the household? 1=Covered containers
2=Open containers
3=Constricted neck/end (Ashuun)
Q34-40 Sanitation and Hygiene (access and quality)
Q34 Type of toilet used by most members of the household: 1=Improved pit latrine (VIP)
2=Traditional pit latrine 3=Open pit
Q35 Distance between toilet and water source
1=0- 30 metres
2=30 metres or more
Q36 what washing agents do you use in your household? 1=Soap
2=Shampoo
3=Ash
4=Plant extracts
Q37 How do you store prepared food?
1= Suspend in ropes/hooks
2=Put in pots beside the fire 3= Put in covered containers
specify _____
4=Designated area 5=Bush
5=None
4= Don’t store
5=
Other,
Q 38 Food Consumption Diversity
Twenty four-hour recall for food consumption in the households: The interviewers should establish whether the previous day and night was usual or normal for the
households. If unusual- feasts, funerals or most members absent, then another day should be selected.
42
Food group consumed: What foods groups did members of the household consume in
the past 24 hours (from this time yesterday to now)? Include any snacks consumed.
Did a member of your
household consume food from
any these food groups in the
last 24 hours?
1=Yes
0=No
Type of food
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Codes:
6=Borrowed
7=Gathering/wild
8=Others,
specify_______
9=N/A
1= Own production
2=Purchases
3=Gifts from
friends/families
4=Food aid
5=Bartered
What is the main source of the dominant food item
consumed? (Use codes above)?
Cereals and cereal products (e.g. maize, spaghetti, pasta, caanjera, bread)?
Meat, poultry, offal (e.g. goat/camel meat, beef; chicken/poultry)?
Eggs?
Roots and tubers (e.g. potatoes, arrowroot)?
Vegetables (e,g, leafy vegetables, tomatoes, carrots, onions)?
Fruits (e.g. water melons, mangoes, grapes)?
Pulses/legumes, nuts (e.g. beans, lentils, green grams, cowpeas)?
Milk and milk products (e.g. goat/camel/ fermented milk, milk powder)?
Oils/fats (e.g. fat, butter, ghee, margarine)?
Sugar and honey?
Fish and sea foods (e.g. fired/boiled/roasted fish, lobsters)?
Miscellaneous (e.g. spices)?
______________
Q39
In general what is the main source of food in household?
Q40
Total number of food groups consumed (filled by enumerator): __________________________
Q41 - 42 Informal and formal Support or Assistance in last three months (circle all options that apply)
Q41
Which of these informal supports did you receive in last three months
1=Zakat from better-off households
2=Remittances from Abroad
3=Remittances from within Somalia
4=Gifts
5=Loans
6=None
7=Other (specify) ____________________
Q42
Which of this formal international or national aid support did you receive in last three months?
1= Free cash
2=Free food
3=Cash for work
4=Food for work
6=Water subsidy
7 Transportation of animals subsidy
8=Veterinary care
43
5=Supplementary food
9=None
10=Other (specify) _______________
7.6APPENDIX 5: QUESTIONNAIRE FOR QUALITATIVE DATA
(Data collected through: key informant interviews, focus group discussions, literature review, general observation)
Name of facilitator____________
No. of participants in focus group (Males/Females)_____________________
Area/Location _________________________
Livelihood
15
___________________________________
a). Population and Demography (Key informants, direct observation and literature review)
•
Estimated population size of a) town/village
•
Is there any unusual population movement in or around this site? _______________________________________
•
If yes from ------------------------ , To:-----------------------------
•
What is the estimated number of households that have moved a) Into the area_____ b) Out of the area _______
•
Who is moving?
•
Who is not moving ? __________________________________________________________________________
b) If sampled population if different_________________
___________________________________________________________________________
What is the cause of the unusual population movement? a) Security
scarcity
b) Food shortage
c) Water
d) others, specify :
What is the effect of the unusual movement on people’s overall well being (health, nutrition, lives)?
b) Food security
•
What is the current main source of food for the households?
•
What is the current main source of income for the households? ______________________________
_____________________________
Has there been any change in the source of household food in the last three months? Yes/No
If yes, what is the change?
Has there been any change in the source of household income in the last three months? Yes/No
Has the change in the means of access to food and income in the last three months affected the food consumed?
Yes/No/Not applicable. If yes, explain how?
15
A livelihood comprised the capabilities, assets, activities and strategies required and pursued by households and individuals for a means of living (FSAU 2005)
44
45
c) Identify the most commonly applied coping strategies by the poorest households, in the last three months (Administer the relevant coping strategies for
each specific livelihood)
Coping strategy Questionnaire – Pastoralist Livelihood
In the past 30 days, if there have been times when you did not have enough food or money to buy food,
has your household had to:
a. Reduce home milk consumption and sell more of milk produced?
b. Consume less preferred cereals
c.
d.
e.
Borrow food on credit from another household (Aamah)?
Reduce number of meals per day?
Reduce the portion size/quantity consumed at meal times (Beekhaamis)?
f.
g.
h.
Rely on food donations (gifts) from the clan/community (Kaalmo)?
Consume weak un-saleable animals (caateysi)?
Send household members to eat (for food) elsewhere?
i.
j.
k.
Skip (go an) entire days without eating (Qadoodi)?
Beg for food (Tuugsi/dawarsi)?
Rely on hunting for food (ugaarsi)?
Coping strategy Questionnaire – Agro-pastoralist Livelihood
In the past 30 days, if there have been times when you did not have enough food or money to buy food,
has your household had to:
a. Shift from high priced cereal varieties to low price cereal varieties?
b. Shift from high quality cereals to low quality cereals (from osolo to obo)?
c.
d.
e.
f.
Borrow food on credit from shop (Deyn)?
Borrow food on credit from another household (Aamah)?
Reduce home milk consumption and sell more of milk produced?
Reduce the number of meals in a day by adults?
g.
h.
i.
j.
Stop all home milk consumption and sell all milk produced?
Rely on food donations (gifts) from the close relatives (Qaraabo)?
Rely on food donations (gifts) from the clan/community (Kaalmo)?
Skip (go an) entire days without eating (Qadoodi)?
k.
l.
Community identified your household as in need of food and fives support? (Qaraan)
Send household children to live or eat with relatives (elsewhere)?
46
1= Yes 2=No
1= Yes 2=No
Coping strategy Questionnaire – Riverine Livelihood
In the past 30 days, if there have been times when you did not have enough food or
money to buy food, has your household had to:
a. Shift to less preferred foods (e.g. white maize to yellow maize)?
b. Reduce the portion size/quantity consumed at meal times (Beekhaamis)?
c. Consume poor quality foods (unsafe or spoilt)?
d. Reduce number of meals per day by one (e.g. from three to two)?
e.
f.
g.
h.
i.
j.
k.
Consume wild foods and fish from the river?
Consume immature crops (fruits or cereals)?
Reduce number of meals per day by two (e.g. from three to one)?
Feed particular members (elderly, children) at the expense of other household members?
Consume seeds meant for future planting?
Borrow food for consumption (to be repaid in future – in kind)?
Eat prohibited/ unacceptable foods (animal skins, grass, roots, clotted blood, tree leaves,
warthogs, etc)?
47
1= Yes
2=No
Baseline Data (collect on first visit and then only if the situation has changed from the preceding months)
b). Shelter: (Observation and key informant interviews)
•
What is the kind of shelter /houses used by the communities in this site?
a) grass thatched mud houses b) other specify
Currently, is there any change in the kind of shelter/houses, the affected community resides in?
c). Water and Sanitation (Household interviews, observation, visits to water points, FGD)
•
What is the usual source of water for this community?
a). protected well b). un-protected well c). water catchments
•
d) river
e)other, specify ___________
Where is fecal matter disposed of? a) latrines _____ b) bush ___ c) Other __________________(specify)
Has there been any change in the source of water in the past three months?
If yes, please specify:
Has there been any outbreak of diarrheal diseases in the past three months?
If yes, please specify:
d) Health Issues
•
Where do the affected households seek for health assistance when sick?
•
a) Hospitals ____ b) MCH/OPD ______ c) Health posts _____ d) private clinic/pharmacy _____e) traditional
•
f) Other specify _____________________
If no, why?
a) Long distance to the health institution
b) other specify ___________________
Are there particular groups of people whose health problems are especially bad? Yes/No
If there is, in what ways?
Reasons:
Has there been any disease outbreaks in the in the area in the last three months? Yes/No
If yes, please explain:
e) Education
•
Are there any formal schools/educational institutions in this area?
Has there been any dropout from schools/educational institutions in the past three months? Yes/No
If yes, indicate the reasons:
48
8. ASSESSMENT TEAM
Serial No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Name
Adan Moalim Hassan
Ali Ibrahim Magan
Abdullahi Hassan Awdahir
Kadar Osman Rashid
Ayhanshe mohammed Husein
Ayan Adan Bile
Abdi Adan hassan
Ahmed Adan Osman
Liiban Abdi Sanior
Ibrahim Ahmed ibrahim
Mohamud Mohamed moalim
Fadumo ají Osman
Rukiya Idle Adan
Kaadro mohamed Ali
Abdirahaman Bare Dubad
Abdiker Sheik Bashir
Kariye Nunow Ali
Moalim Ugas Isaak
Mohamed Abdi Ali
Ibrahim Moalim Abdirahaman
Abdulahi Shidiye Dhagane
Adan Ibrahim Isaac
Safia Dhagane Hanshi
Adan Ali IBrahim
Said issk Kalmoy
Ajéis Sheik Mohamed
Farah Bile Mohamed
Ibrahim A Hussein
Mohamed Hassan Gani
Khaliif Nouh Abdullah
Ibrahim Mohamed
Osman Warsame
Josephine muli
Mohamed Mudir
Barnabas Okumu
Hersi Mohamoud
Abdirizak
Peter Kingori
Agency
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
WVI
FSAU
FSAU
FSAU
FSAU
WVI
WVI
WVI
WFP
FSAU
FSAU
41
Ahono Busili
FSAU
42
Noreen Prendiville
FSAU
Role
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Enumerator
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Data entry
Data entry
Data entry
Trainer/Field supervisión and coordination
Logistical coordination
Aanalyzed the food security situation
Analyzed the food security situation
Nutritionist – Assisted in technical coordination,
supervised data entry
Coordinated the Assessment
Data Análysis and report writing
Provided Technical Advice, overall leadership and
managerial support at all stages of the assessment
9. REFERENCES
Nutrition Assessment Guidelines for Somalia: Nutrition Working Group, January 2005
FSAU Monthly Nutrition Update March 2006
Measuring Mortality, Nutrition status and Food Security in Crisis Situations: SMART Methodology
FSAU 2005/06 Post Deyr Analysis, February 2006

Buale Sakow Nutrition Assessment - April 2006

Transkript

Benzer belgeler

Middle and Lower Shabelle Sub-National

D. Esra ANGIN1, Nazan AKTAŞ2, Muhammet Ali CEBİRBAY3 A

PDF

Nutritional status of patients hospitalized in pediatric clinic

Consumer credit risk factors of Turkish households1

SLDDC Nutrition Educator Inducted Posthumously into Dairy Hall